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NFL Divisional Playoff Injury Report

I’m hoping that future Hall of Famer Ed Reed, Baltimore Ravens safety, isn’t too banged up to put on a show Sunday in New England.

Reed was a difference-maker in this weekend’s matchup against the Texans but landed hard on his left hip in the first half, and in the next to last play of the game rolled his left ankle. Though x-rays of the ankle were negative, and Reed claims he’ll be good to go, he isn’t likely to be feeling too great about now… hopefully only a Grade I ankle sprain and a mild hip contusion.

Giants safety Deon Grant passed concussion tests after leaving the field in the third quarter in the contest against Green Bay. Awaiting further reports…

John Kuhn, Packers’ fullback, suffered an unspecified knee injury in the third quarter and did not return. Unfortunately for Green Bay, he will have plenty of time to recover. A less than impressive performance by a team that deserved the spotlight all season long, and a surprising demonstration by the Giants, a team that has been peaking at the perfect time…

A healthy New England put the clamps on Denver, and the absence of the Broncos’ prized wide receiver, Eric Decker, (knee) wasn’t likely the cause. Some reports claim the loss was in part due to the fact that starting safety Brian Dawkins was out with a neck injury, while other starting safety, Quinton Carter, left the game in the first half, also with a neck

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injury. Denvers’ strong safety David Bruton and DT Brodrick Bunkley exited mid-game as well (in the third), both with concussions. The game was long over by then… The number of concussions in the NFL remains a particularly scary issue.

The Patriots suffered fewer in-game losses, with only TE Aaron Hernandez leaving the game in the fourth, also with a head injury after absorbing a hard hit.

Somehow, I don’t think an intact Broncos team would have had a chance against the Pats the way New England played on Saturday. A disappointing game, especially after all the hype that preceded it…

What drama in San Francisco – the game was riveting! Niners’ TE Delanie Walker didn’t play against the Saints because of a fractured jaw, sustained in late December. AP reports he is hoping to play for the NFC Championship. As with other playoff teams, several players were inactive or questionable at game time. Those suffering mid-game injuries included Niners’ center Jonathan Goodwin who hurt his left lower leg in the second quarter but returned to the game shortly thereafter. Receiver and kick-return man Ted Ginn Jr. wasn’t certain to start due to a prior ankle sprain. Though he was out

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there, he was hurting enough by

mid game (with either an ankle flare-up or a new ankle injury) to merit some time on the bench. Though Ginn returned for a brief time, he was removed again in the third quarter after sustaining a knee injury. I would be very surprised to see him return for the NFC Championship.

New Orleans was missing WR Lance Moore, who was inactive due to a hamstring injury, and had several other players dealing with prior injuries not thought serious enough to keep them from playing. In-game losses included Saints RB Pierre Thomas who had a head injury in the first quarter and Jimmy Graham, who scored a touchdown after returning to the game in the second quarter after suffering a lower extremity injury earlier in the game. The injured Saints, along with those banged up on the Packers, Broncos and Texans will have the next six months to heal.

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Abby on Twitter @abcsims

Do you think Ed Reed will be hampered by his injuries this weekend?

Patellar Tendon Ruptures in the NFL

ets’ safety, Jim Leonhard, is the newest member of the NFL’s ruptured patellar tendon club, after suffering the injury in last Sunday’s victory over Kansas City. As expected, surgery will end Leonhard’s season, the second consecutive year that injury has shut him down early. Last year he fractured his right tibia (leg), the same side injured this week.

Arizona Cardinals’ rookie, and second round draft pick, Ryan Williams, has been sitting out the entire 2011 season with a right patellar tendon rupture that he sustained during a pre-season game. Only 20 years old at the time of his injury, Williams is missed on a Cardinals team that has been rebounding from a rough start and might be playoff bound if he’d been out there.

Last year’s victims of a torn right patellar tendon included Nate Allen, a rookie safety on the Eagles who was injured in December of 2010, and Clint Sintim, NY Giants linebacker, who was sidelined during a pre-season game.

Interesting that all the injuries were on the right side…

The patellar

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tendon is a part of the extensor mechanism of the knee and it serves to connect the patella (kneecap) to the tibia (larger bone of the lower leg). The extensor mechanism acts to straighten (extend) the knee, and is also comprised of the four quadriceps muscles of the front of the thigh, the quadriceps tendon (which attaches the quads to the patella), the ligaments that help to stabilize the patella (by providing a connection to the femur (thigh bone) above and to the tibia below), and also by other soft tissues on either side that help stabilize the patella and other structures of the knee.

Patellar tendon ruptures are relatively rare and they occur most often in people younger than 40 (most are in their teens or twenties). Ruptures can either be partial or complete. Complete ruptures should be surgically repaired quickly in order to enable the tendon to be sutured end-to-end. This also optimizes outcome. Waiting would result in retraction of the tissue and make a repair more difficult. The upper (proximal) portion of the patellar tendon ruptures more often than the lower. Some of these proximal ruptures pull a piece of bone away from the lower part of the patella; this type of injury is called an avulsion of the patella. It has been noted that African Americans have a greater predominance of patellar avulsions than other groups.

A complete rupture of the patellar tendon renders the quadriceps helpless, making it impossible to straighten the knee. A partial rupture makes extension difficult and is likely to make it impossible to straighten the knee through the end-range of motion.

Post-operative rehab is (as coaches say about almost everything), a process. Controlling pain and swelling in the initial phase, while also addressing mobility of the scar and surrounding soft tissue is crucial. Care must be taken to protect the repair and avoid stretching the sutured tendon too quickly, while ultimately restoring full range of motion – thereby enabling the knee to bend. Weight bearing is gradually resumed and assistive devices (crutches and canes) are eliminated once the extensor mechanism is strengthened sufficiently to fully support ambulation without significant gait abnormalities. Muscle strengthening, flexibility and endurance, as well as overall mobility and agility are all a part of rehabilitation.

A study on the recovery of NFL players who suffered patellar tendon ruptures concluded that the injury occurs most often with eccentric overload* of the extensor mechanism. It also noted that anterior cruciate ligament (ACL) tears occasionally accompany patellar tendon ruptures in the NFL, and that players without complications from other injuries generally return to play the following season. The study also found that players who’d been chosen earlier in the draft were more successful in returning to play.

• An eccentric muscle contraction is one when the muscle is actually lengthening while it is working. An example would be the second phase of a biceps curl when the elbow is straightening, thereby lengthening the biceps while the muscle works against gravity (and added weight) to slowly return the arm to its resting position.

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Details on Cervical Disk Injuries and Neck Pain

The NY Giants h

ave reported that Mathias Kiwanuka will be out of action for an undetermined period of time after receiving a diagnosis of a bulging cervical disc.  Though he had reportedly only complained of stiffness in his neck, a precautionary MRI revealed the extent of Kiwanuka’s injury.  The Giants and Kiwanuka are smart to play this one safe, particularly due to the nature of the sport and the inherent risk involved even when there is no known injury. 

Explaining the spine

The spine is the support system for the head and trunk and it encases and protects the spinal cord, from which the many nerves of the upper and lower body emerge.  The bones of the spine are called vertebrae, and with the exception of those at the very top and at the lowermost segments, the bodies of the vertebrae are separated by discs.  In addition to the vertebral bodies, which are at the front of the spine, other bony components at the sides and back of the vertebrae surround the cord and have openings through which the nerves exit the spinal column.

 The role of the discs is to connect one vertebra to another (vertebrae also connect via small joints on either side) while allowing for movement between them.  Discs also contribute to the stability of the spine and provide shock absorbency.  The shape of both the bodies of the vertebrae and the discs, which vary by section of the spine, results in the natural and normal spinal curvature that enables it to best serve our needs.

 The spine is divided into five segments.  The neck, or cervical spine is the uppermost portion; it is comprised of seven vertebrae.  Below the cervical spine is the thoracic region, whose 12 vertebrae also serve as attachments to the ribs via cartilage.  It is this cartilage that Michael Vick reportedly bruised in the brutal double hit yesterday that led team doctors to initially suspect a rib fracture.  The lumbar spine in the low back has 5 thick vertebrae. Below the lumbar spine is the sacrum, which lies between the two pelvic bones.  It is actually one bone that was formed by the fusing of what initially were five.  The lowermost segment is the coccyx, or tailbone.

 What is a bulging disc? A herniated disc?  A slipped disc?

 Trick question, technically, there is no such thing as a slipped disc.

 Discs have a firm fibrocartilaginous exterior rim and a softer, more gelatinous interior that contains a great deal of water, collagen and proteins.  Discs help to resist compressive loading of the spine, and they are most often injured in the neck and low back because these are the regions where there is the greatest movement and stress to the spine.  Though cervical discs commonly sustain injuries in the lower segments of the cervical spine, studies have demonstrated that football players have an unusual number of injuries to the disc between the third and fourth vertebrae when they lead with the helmet in making a tackle.  I have not seen reports of the level of Kiwanuka’s injury (See Wheeless’ Textbook of  Orthopaedics).

 When the firm outer rim of the disc bulges, the injury is less likely to produce significant neurologic symptoms.  This is because the disc has not actually torn and so the inner gel of the disc remains contained.  The area may hurt because of stimulation of pain receptors and other nerve endings, localized swelling and inflammation.  When the disc tears, or herniates, the inner portion leaks out and can create more significant pressure on the nerve roots, where the nerves exit the spine, or on the spinal cord itself.  Some herniations cause only sensory symptoms such as numbness or tingling, while others also cause motor symptoms, or weakness.  The type and degree of symptoms depends on which portion of the disc herniates and where the resulting pressure occurs.  Symptoms include neck pain, radiating pain, and/or numbness or weakness into the arm or hand on the same side as the disc herniation.  If symptoms occur on both sides, it is likely that the herniation is more central rather than on one side or the other.  Pain is generally intensified with movement of the neck, particularly leaning backward into an extended posture.  The nerve may be further compressed by turning the head toward the involved side, increasing symptoms.

 There are other conditions that can result in symptoms similar to those from a cervical disc herniation.  Nerves can be compressed in the wrist causing symptoms in the hand (as from Carpal Tunnel Syndrome), in the elbow region (causing symptoms below the elbow), or even in the region of the first rib (Thoracic Outlet Syndrome).  Tightness in the nerves in the upper extremity can also result in numbness and tingling symptoms in the arm and hand and can be very easily addressed.  Obtaining an accurate diagnosis is very important.

 Mathias Kiwanuka will be on the sidelines in the hope that his bulging disc resolves.  By not playing he is taking an important precaution to avoid allowing an already vulnerable disc to progress to herniation.

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